Introduction: Defining the Issue
Understanding the Study Variables: Sexual Response/Dysfunction and Pornography Use
Sexual Response/Dysfunction and Its Assessment
Pornography Use and Its Assessment
Instrument | Description | Used in study |
---|---|---|
Brief Pornography Screening (BPS) | A 5-item assessment used to detect problematic pornography use | [23] |
Youth Pornography Addiction Screening Tool (YPAST) | A 25-item scale measuring 3 components: lack of control over pornographic behavior, regret after pornography use, and pornography for sexual arousal | [24] |
Pornography Addiction Screening Tool (PAST) | A 25-item assessment focusing on assessment of a range of pornography use | [25] |
Problematic Pornography Consumption Scale (PPCS) | A 12-item self-reporting scale assessing four dimensions of IPU | [26] |
Cyber Pornography Addiction Test (CYPAT) | A brief screening measure used to assess addiction to cyber pornography | [27] |
Online Pornography Test (OPT) | A 12-item test to determine if a person has an issue with the use, abuse or addiction to online pornography | [28] |
The Pornography Craving Questionnaire (PCQ) | A 12-item scale assessing the craving to use pornography | [29] |
Internet Sex-screening test (ISST) | A 25-item test assessing 5 dimensions (online sexual compulsivity, online sexual behavior-social, online sexual behavior-isolated, online sexual spending, and interest in online sexual behavior) | [30] |
Problematic Pornography Use Scale (PPUS) | A 12-item test measuring 4 domains (distress and functional problems, excessive use, control difficulties, and use for escape/avoidance of negative emotions) | [31] |
Short Internet Addiction Test adapted to online sexual activities (s-IAT-sex) | A 12-item questionnaire measuring two dimensions of on-line PPU | [32] |
Cyber-Pornography Use Inventory (CPUI-9) | A 41-item instrument used to assess internet pornography usage as it relates to behavioral patterns of addiction | [33] |
The Controversy
Goals of This Paper
Methodology
Results
Methodological Issues
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Sampling: The relationship between pornography use and sexual function has sometimes been investigated in clinical or patient samples, or other specialized samples. Such samples are typically biased, as they focus on individuals who are seeking help for an existing health-related problem—specifically, these individuals may already have a sexual dysfunction and/or be in poorer general health than the population at large. Beyond this, sample sizes need to be sufficiently large to ensure well-powered studies both to accommodate multivariate analyses and to enable confidence in studies that report a lack of associations/effects.
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Defining/operationalizing variables: For the outcome variable (sexual function/dysfunction), standardized assessment instruments have not always been used, even when available; or cut-off scores for dichotomized outcomes (function vs dysfunction) have neither been reported nor justified; or clear justification for, and psychometrics of, an operationalizing procedure (when standardized assessments have not been used) have not been included. For non-standardized predictor and correlated variables, internal and test–retest reliability statistics are seldom reported—often, best psychometric practices are not followed.
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Over-reliance on bivariate relationships: Simple bivariate associations provide little insight into the overall issue and, more importantly, may lead to erroneous conclusions, particularly given that confounding variables may better explain an outcome than pornography use. Even for studies taking a multivariate approach, the included covariates may not represent those most critical to the issue. Some studies have also failed to report effect sizes, making them uninterpretable.
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Use of cross-sectional methodologies: Although not a problem in and of itself, this becomes an issue when a study infers a directional effect, for example, pornography use → sexual problem (e.g., ED) and does not seriously consider equally plausible bidirectional or opposite direction effects: for example, individuals suffering from a sexual problem sometimes turn to masturbation and concomitant pornography use for sexual pleasure when partnered sex is difficult or not readily available.
Findings From Major Reviews Since 2016
Review and Update of Research Studies
The Roadmap
Studies Based on Community Samples
Women
Evaluation and Comment on Women’s Community Sample Studies
Men
Evaluation and Comment on Men’s Community Sample Studies
Studies Based on Special Populations of Pornography Users (PPUs, Compulsive Users, etc.)
Women
Evaluation and Comment on Women Problematic Pornography Users
Men
Evaluation and Comment on Men Problematic Pornography Users
Discussion
Methodological Issues Revisited
Mediating/Moderating Covariates and Correlates Between Pornography Use and Sexual Functioning
Variable | Type of variable | Reference |
---|---|---|
Sexual flexibility (women only) | Mediating/moderating | [49] |
Masturbation frequency | Covariate | |
Importance of/desire for sex | Covariate | |
Self-competence | Covariate | [50] |
Motivation: emotional avoidance vs. curiosity | Organizing variable | [43] |
Motivation: recreational vs. compulsive | Organizing variable | |
Situational: isolated vs. social vs. compulsive | Organizing variable | [46] |
Sexual insecurity | Mediating/moderating | [51] |
Relationship parameters/assumptions/pressures | Organizing variable | |
Moral incongruence | Mediating/moderating | |
Age of first exposure | Covariate/mediating | |
Dyadic use/communication | Covariate | [57] |
Anxiety or depression | Covariate | |
Other addictions | Covariate | [56] |
Tolerance and escalation | Covariate/mediating | [72] |
Putative Domains/Constructs Related to Problematic Pornography Use: A Path Forward
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Motivation-reward systems: Studies have identified not only various reason/goals in using pornography but also level of sexual desire/drive/craving as relevant factors for both pornography use and sexual functioning [7, 21, 77••]. Various reinforcers (pleasure, anxiety reduction, etc.) result in strongly entrenched habitual behaviors
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Relational: General relationship satisfaction and intimacy are important to sexual functioning (e.g., “secret” pornography use may engender trust issues) but also impact (and are impacted by) pornography use and masturbation frequency [2••, 38•]. Limited/absent relationship experience and/or a strong autoerotic orientation characterize both PPU and partnered sexual problems
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Contextual influences: Each individual’s beliefs about and experience of pornography are significantly shaped by factors such as family of origin values, peer influences, community norms, societal statutes, and national policies [81]